Next Steps

1. Next Steps Robert A. Gabbay, MD, PhD Professor of Medicine, Penn State College of Medicine

2. Until we meet again… • Use your practice facilitator as a resource • Meet with and call Patty/Sharon: Pick a date today! • Reflect on and respond to their feedback • Continue (or start) holding weekly team meetings • Develop a plan to collect any data you don’t have or correct any data you know is wrong • Continue implementing: • Population alert • Use of template/flow sheet with embedded guidelines • Standing orders • Planned care at every visit

3. Until we meet again… • Start testing self-management support • Patient report cards • Collaborative goal setting • Think about risk assessment and follow-up interventions for varying levels of risk • Frequency of visits • Follow-up phone calls • Clinical protocols • Identify diabetes patients overdue for visits and reach out to them to schedule a visit and provide follow-up care

4. Until we meet again… • Show significant and sustained improvement in at least 1 outcome measure and 3 process measures • Keep on reporting PDSAs, data, status reports • Participate in webinars: 4th Thursday of month (except for Nov and Dec), 12pm-1pm • Sept. 27 ▪ Oct. 25 • Nov. 15 ▪Dec. 20 • Tell us what you need!

5. Monthly Report Due Dates 2012 2013 January 7 February 5 March 5 April 5 May 6 June 5 • October 5 • November 5 • December 5

6. Learning Session #3 South Central • Jan. 29: 5-9pm at PSU College of Medicine, Hershey Northwest • Jan. 22: 5-9pm at PSU Behrend, Erie

7. Practice Facilitators • Northwest Patricia J. Stubber, MBA Executive Director Northwest PA AHEC 8425 Peach Street Erie, PA 16509-4788 814-217-6029 (phone) 814-594-4740 (cell) 814-864-4077 (fax) pstubber@nwpaahec.org • South Central Sharon M. Adams RN, BA Executive Director Southcentral PA AHEC PO Box 509 Carrolltown, PA 15722 814-344-2222 (phone) 814-344-2221 (fax) sadams@scpa-ahec.org Web: www.paspread.com Email: paspread@hmc.psu.edu